| prevention-news@cdcnpin.org 2005-02-01, 2:43 pm |
| CDC HIV/STD/TB Prevention News Update
Monday, January 31, 2005
The CDC National Center for HIV, STD and TB Prevention provides the follo=
wing information as a public service only. Providing synopses of key scie=
ntific articles and lay media reports on HIV/AIDS, other sexually transmi=
tted diseases and tuberculosis does not constitute CDC endorsement. The f=
ollowing summaries were prepared without conducting any additional resear=
ch or investigation into the facts and statements made in the articles be=
ing summarized, and therefore readers are expressly cautioned against rel=
ying on the validity or invalidity of any statements made in these summar=
ies. This daily update also includes information from CDC and other gover=
nment agencies, such as background on Morbidity and Mortality Weekly Repo=
rt (MMWR) articles, fact sheets and announcements. Reproduction of this t=
ext is encouraged; however, copies may not be sold, and the CDC HIV/STD/T=
B Prevention News Update should be cited as the source of the=20
information. Contact the sources of the articles abstracted below for ful=
l texts of the articles.
HEADLINES
NATIONAL NEWS
UNITED STATES: =93US Is Close to Eliminating AIDS in Infants, Officials S=
ay=94
UNITED STATES: =93TB Cases Prompt US to Halt Hmong Resettlement=94
INTERNATIONAL NEWS
AFRICA: =93New Push for Public Health, AIDS Spending at African Union Sum=
mit=94
UNITED KINGDOM: =93British Gay Lawmaker Inspired by Mandela to Go Public =
with HIV Status=94
MEDICAL NEWS
KENYA: =93Female-to-Male Infectivity of HIV-1 Among Circumcised and Uncir=
cumcised Kenyan Men=94
LOCAL AND COMMUNITY NEWS
GEORGIA: =93Abstinence education Not Enough, Say Parents=94
NEW YORK: =93Reaching Crystal Meth Injectors=94
NEWS BRIEFS
GLOBAL: =93UNAIDS Chief Kept=94
NORWAY: =93Mandela to Attend Concert in His Honor=94
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NATIONAL NEWS=09
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UNITED STATES:
=93US Is Close to Eliminating AIDS in Infants, Officials Say=94
New York Times (01.30.05)::Marc Santora
Across the United States, mother-to-child transmission of HIV has dr=
opped so dramatically that public-health officials now speak of wiping it=
out. In 1990, as many as 2,000 US babies were born with HIV. Now, health=
officials report, that number has been cut to just more than 200 a year.=
In New York City in 1990, newborn infections peaked at 321. In 2003, onl=
y five babies were born HIV-infected in the city. Better drugs, aggressiv=
e education and testing campaigns, and cooperation at the federal and loc=
al levels are credited with the decrease.
Given the scope of the problem 20 years ago, the advances are consid=
ered stunning. While federal officials did not track infant HIV infection=
s nationwide, they did count infant AIDS cases =97 a figure that topped =
out near 900 in 1992.=20
Though health officials suspected AZT could reduce HIV in the blood =
and cut the chance of transmission, they were reluctant to give the drug =
to pregnant women. Eventually, the National Institutes of Health allowed =
a test in which some mothers were give AZT and others were given a placeb=
o. The study showed a 67 percent reduction in the risk of transmission am=
ong the AZT group. The government quickly allowed the women in the placeb=
o group to take AZT, and their babies, too, had a lower infection rate. S=
oon, HIV-positive pregnant women across the nation were being treated.=20
CDC reports there is a 20 to 25 percent chance an infected mother wi=
ll pass the virus to her baby without intervention. A year after the intr=
oduction of AZT treatment, the risk had dropped to 8 percent, said Dr. Ly=
nne Mofenson, chief of the Pediatric, Adolescent and Maternal AIDS Branch=
of the National Institute of Child Health and Human Development.=20
Since that time, a combination of improved drugs, more rigorous test=
ing and partner notification, and more awareness of safe-sex practices ha=
s cut the risks of mother-to-child transmission even further.=20
UNITED STATES:
=93TB Cases Prompt US to Halt Hmong Resettlement=94
Associated Press (01.28.05)::Xiao Zhang
On Friday, US State Department officials announced they had temporar=
ily halted the resettlement of Hmong refugees after discovering active TB=
cases among refugees already in the United States and at the Wat Tham Kr=
abok camp in Thailand. Around 6,000 Hmong =97 an ethnic minority who fled=
communist-seized Laos after the Vietnam War =97 are at the camp awaiting=
US resettlement, primarily to California, Minnesota and Wisconsin.
Earlier this month, federal and state health officials reported a cl=
uster of TB cases among Hmong refugees, prompting the State Department to=
cancel flights from the camp on Jan. 21. In California, about 20 cases o=
f active TB were discovered, including some that were first-line drug res=
istant, said Sue Levy, section chief of immigrant integration with the Wi=
sconsin Department of Workforce Development.=20
Four out of the 2,100 newly arrived refugees in Wisconsin were diagn=
osed with active TB, said Dr. Jeffrey Davis, the state's chief medical of=
ficer for communicable diseases. =93Each of these individuals is receivin=
g the appropriate medications, and there has been no spread of the diseas=
e to other residents,=94 Davis noted in a written statement.=20
Since the summer, 1,852 Hmong refugees have settled in St. Paul and =
560 in Minneapolis. Minnesota has confirmed one TB case in a recent arriv=
al and four other cases are suspected in children, said Kris Ehresemann, =
a state Health Department TB expert. Dr. Harry Hull, state epidemiologist=
for Minnesota, said the confirmed case is not the multi-drug resistant t=
ype, but it is too early to know about the four unconfirmed cases.
Although all the refuges underwent TB screening at the camp prior to=
arriving in the United States, the disease can be slow to diagnose, and =
it can take multiple testing to determine TB's presence, said Tanya Oemig=
, director of Wisconsin's Tuberculosis Program.
CDC is sending six health officials to Thailand to help control TB a=
t the camp.=20
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INTERNATIONAL NEWS=09
************************************************************
AFRICA:
=93New Push for Public Health, AIDS Spending at African Union Summit=94
Agence France Presse (01.29.05)::Lauren Gelfand
At the African Union summit held over the weekend in Nigeria, activi=
sts expressed hope that the union's 52 countries will make good on commit=
ments to boost government spending on public health and AIDS.=20
=93We are definitely optimistic that this time there will be some mo=
vement, that this time there will be not just talk about an HIV strategy =
for the AU but how to tackle an action-oriented plan,=94 said Shehnilla M=
ohamed of the British aid group Oxfam. =93Governments are learning that f=
ighting AIDS is not just a health issue but a development issue. Now they=
have to deliver on the existing protocols and develop a serious =97 and =
practical =97 strategy.=94
To date, Mozambique is the only country committed to allocating 15 p=
ercent of its gross domestic product to health care since the goal was st=
ated four years ago at the pan-African body's founding. The remaining AU =
member countries spend less than 10 percent of their GDP on health, HIV/A=
IDS efforts included.=20
Increasing the number of HIV/AIDS patients on antiretroviral (ARV) d=
rugs has been a major challenge facing African governments. The World Hea=
lth Organization reported that 310,000 Africans were on ARVs as of Decemb=
er. While that number is more than double the figure from June, some 3.7 =
million Africans are still in need of treatment.=20
UNITED KINGDOM:=20
=93British Gay Lawmaker Inspired by Mandela to Go Public with HIV Status=94
Associated Press (01.30.05)
On Sunday, Britain's first openly gay lawmaker, Chris Smith, reveale=
d he has been HIV-positive for 17 years. The former Labor Party culture s=
ecretary cited anti-apartheid icon Nelson Mandela as his inspiration to t=
alk publicly about HIV and fight AIDS stigma. Earlier this month, the for=
mer South African president called for more openness about HIV/AIDS as he=
disclosed that his oldest son, Makgatho Mandela, had died of the disease=
..=20
=93What Nelson Mandela said very much struck a chord with me,=94 sai=
d Smith, according to the Sunday Times newspaper. =93He spoke about how n=
obody should be ashamed of HIV and said that it should be regarded just l=
ike any other illness. He was brave and right,=94 said Smith, who announc=
ed he was gay a year after being elected to Parliament in 1983.=20
Smith did not reveal his HIV status to Prime Minister Tony Blair. =93=
I didn't feel the need to tell people, except for a very, very few, as it=
was not in any way affecting my work,=94 said Smith, who received treatm=
ent shortly after being diagnosed in 1987.=20
Smith, 53, worried how revealing his HIV status would affect his par=
ents and others but did not regret going public. =93If I can help to demy=
stify this, if I can help to challenge a little bit of prejudice, if I ca=
n help to give a little bit of greater confidence to other people who are=
affected in the same way, well, let's say something,=94 Smith told Briti=
sh television station GMTV. =20
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MEDICAL NEWS=09
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KENYA:=20
=93Female-to-Male Infectivity of HIV-1 Among Circumcised and Uncircumcise=
d Kenyan Men=94
Journal of Infectious Diseases (02.15.05) Vol. 191; No. 4: P. 546-553::Ja=
red M. Baeten; Barbara A. Richardson; Ludo Lavreys; Joel P. Rakwar; Kisho=
rchandra Mandaliya; Job J. Bwayo; Joan K. Jreiss
The vast majority of new HIV infections are heterosexually transmitt=
ed, particularly in sub-Saharan Africa, where the pandemic has had the gr=
eatest impact. While many biological and behavioral factors likely contri=
bute to country-by-country variation in HIV's spread, ecological and larg=
e-survey studies suggest that one explanation may be differences in frequ=
ency of male circumcision. The lack of male circumcision has been associa=
ted with increased HIV acquisition risk in studies. The current study mod=
eled the per-sex act probability of female-to-male HIV-1 transmission for=
circumcised and uncircumcised men, including for those with multiple par=
tners.
During 1993-1997, researchers enrolled 992 HIV-negative employees of=
six trucking companies in Mombasa, Kenya. Demographic, employment, and s=
exual history were recorded and circumcision status was determined. Data =
on sexual behavior during the previous three months with each of three pa=
rtner types (wives, casual partners, prostitutes); number of sex acts in =
which condoms were used for each partner type; STDs (by physical exam) an=
d HIV (by blood test) were collected in quarterly follow-up visits. Risk-=
reduction counseling and free condoms were also provided. Of participants=
, 76 percent returned for at least one visit and were similar to those lo=
st to follow-up in terms of demographics, sexual and condom use history, =
and circumcision rates. The analysis was based on 745 men, of whom 95 (13=
percent) were uncircumcised.
Circumcised men were more likely to be older; Muslim; married; repor=
t condom use; and to report extramarital sex. Sexual activity with a wife=
was reported by 573 men (77 percent); with a casual partner by 474 men (=
64 percent); and with a prostitute by 182 men (24 percent). The monthly m=
edian number of sex acts was 4, of which 3.8 were without condoms. Unprot=
ected sex was common with wives (99 percent), casual partners (85 percent=
) and prostitutes (71 percent). The majority of sex acts (84 percent) wer=
e with wives, followed by casual partners (15 percent) and prostitutes (1=
..5 percent). Sexual behavior did not significantly differ by circumcision=
status.=20
Among the 745 men included for analysis, the overall probability of =
HIV-1 infection per penile-vaginal sex act was 0.0063. Female-to-male inf=
ectivity was significantly higher for uncircumcised than for circumcised =
men (0.0128 vs. 0.0051). =93The effect of circumcision was robust in subg=
roup analyses and across a wide range of HIV-1 prevalence estimates for s=
ex partners,=94 with approximately a 2- to 3-fold greater infectivity for=
uncircumcised than for circumcised men across all prevalence estimates f=
or sex partners.=20
=93After accounting for sexual behavior, we found that uncircumcised=
men were at a >2-fold increased risk of acquiring HIV-1 per sex act, com=
pared with circumcised men,=94 the researchers concluded. =93Moreover, fe=
male-to-male infectivity of HIV-1 in the context of multiple partnerships=
may be considerably higher than that estimated from studies of HIV-1-ser=
odiscordant couples. These results may explain the rapid spread of the HI=
V-1 epidemic in settings, found throughout much of Africa, in which multi=
ple partnerships and a lack of male circumcision are common.=94 =20
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LOCAL AND COMMUNITY NEWS=09
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GEORGIA:
=93Abstinence education Not Enough, Say Parents=94
Atlanta Journal-Constitution (01.29.05)::Jen Sansbury
This year, the sex-education program Choosing the Best is being intr=
oduced in DeKalb County's eighth-grade health classes. The program teache=
s students they should abstain from sex until marriage. But during a rece=
nt presentation, concerned parents of Shamrock Middle School students cha=
llenged Bruce Cook, CEO of Choosing the Best, about the program. They sai=
d it should include more information about preventing pregnancy and disea=
se. The audience of about 50 parents included doctors, scientists and res=
earchers with specialties in infectious diseases who work at nearby Emory=
University, its hospital system and CDC.
The program highlights the failure rate of condoms; critics say its =
negative approach to contraception and disease prevention may discourage =
sexually active teens from protecting themselves. Cook responded that tee=
ns need consistent, firm abstinence messages.=20
=93We have tried fear-based programs in the past,=94 said Tanya Cass=
ingham, an Emory AIDS research coordinator. She questioned why the distri=
ct chose a program that is not peer-reviewed by the scientific community;=
this process would affirm that the information presented is widely held =
to be fact, not opinion. Cook said the materials are medically accurate.=20
DeKalb officials said Choosing the Best represents only new suppleme=
ntary material, not a change in philosophy. Teachers may opt to use as mu=
ch or little of it as they wish. The materials and teacher training were =
provided free of charge.
Choosing the Best is receiving $2.4 million over three years to serv=
e eight Georgia districts. The federal funds were awarded directly to the=
company and do not pass through the Georgia Department of Human Resource=
s, Cook said.=20
Lynn Cherry Grant, a member of the school board, expressed concern a=
bout the =93conservative agenda=94 behind Choosing the Best.
NEW YORK:=20
=93Reaching Crystal Meth Injectors=94
Gay City News (01.27.05)::Duncan Osborne
Last year, the Lower East Side Harm Reduction Center distributed 600=
,000 free clean syringes and collected 550,000 used needles in its missio=
n to prevent blood-borne diseases among injecting drug users. During that=
time, the center saw more gay and bisexual men who inject crystal metham=
phetamine visit its Allen Street drop-in site.=20
The roughly 30 gay or bisexual men who visited in the last year were=
mostly white, had housing and jobs, were in their mid-30s, and had used =
crystal for less than a year, said Sam Orlando, the center's vital servic=
e care coordinator. =93They come and go,=94 =93It's very private. They're=
not interacting with the other clients,=94 he said. =20
The men Orlando counseled knew enough not to share their needles. Bu=
t they did not necessarily know that sharing the water used to clean a ne=
edle or a dish used to mix the drug could also transmit viruses and bacte=
ria. Three of the men tested HIV-positive while they were clients; Orland=
o estimated one-third were positive. Less than five of the men were ready=
to quit using crystal and be referred for treatment, he said. Most wante=
d to know how to inject safely and not overdose. =20
Orlando and another staff member have taught proper injection techni=
ques at several gay sex clubs and private parties they knew to be =93hot =
spots.=94
The center has applied to the state to expand its syringe exchange p=
rogram waiver, which limits where the exchange can operate, to include th=
e West Village. =93As we are doing more outreach, we are bumping into mor=
e people,=94 said David Rosenthal, the center's executive director. The W=
est Village community board has been =93very supportive=94 on expanding t=
he waiver.
Founded in 1992, the harm-reduction center has a $1.3 million budget=
, 21 staff members, and served some 2,500 people in 2004, said Rosenthal.
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NEWS BRIEFS =09
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GLOBAL:=20
=93UNAIDS Chief Kept=94
Washington Times (01.31.05)::Betsy Pisik
The tenure of UNAIDS Executive Director Dr. Peter Piot has been exte=
nded for another four years, agency officials announced. =93This is a cru=
cial time in our fight against the epidemic and in our work to mobilize t=
he world against this unique threat to human development and security,=94=
UN Secretary-General Kofi Annan said of the decision to renew Piot's app=
ointment. Piot, a Belgian physician who also holds a doctoral degree in m=
icrobiology, directs the work of almost a dozen UN agencies fighting HIV/=
AIDS. =20
NORWAY:
=93Mandela to Attend Concert in His Honor=94
Associated Press (01.29.05)
Nelson Mandela has said he will attend an AIDS concert benefiting hi=
s 46664 charity in the Arctic city of Tromsoe, city officials announced F=
riday. The campaign takes its name from the number Mandela was assigned w=
hen imprisoned under apartheid. Organizers have yet to set a program for =
the concert, scheduled for June 11, but hope to draw some of the world's =
biggest stars to Tromsoe, a city about 217 miles north of the Arctic Circ=
le. =93It means a great deal to us and for the event that Nelson Mandela =
wants to visit Tromsoe,=94 said city Mayor Herman Kristoffersen.
************************************************************
ANNOUNCEMENT: The Presidential Advisory Council on HIV/AIDS will meet on =
Feb. 7 from 8:30 a.m. to 5 p.m. and on Feb. 8 from 8:30 a.m. to 4 p.m. at=
the Hubert H. Humphrey Building, 200 Independence Ave. SW, Room 800, Was=
hington D.C. 20201. For more information, please telephone Dana Ceasar at=
202-690-2470. =20
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